Provider Demographics
NPI:1922309129
Name:NICHOLAS JOHN CAPOS JR MD INC.
Entity Type:Organization
Organization Name:NICHOLAS JOHN CAPOS JR MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CAPOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,
Authorized Official - Phone:530-673-6140
Mailing Address - Street 1:1044 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3415
Mailing Address - Country:US
Mailing Address - Phone:530-673-6140
Mailing Address - Fax:530-673-3144
Practice Address - Street 1:1044 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3415
Practice Address - Country:US
Practice Address - Phone:530-673-6140
Practice Address - Fax:530-673-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G414570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0729418Medicare UPIN
CA00G414570Medicare PIN